Socioeconomic inequalities and diabetes complications: an analysis of administrative data from Hungary

Diabetes complications are associated with increased healthcare costs and worsened patient outcomes. In this paper, we analyse how individual-level demographic and territorial-level socioeconomic and healthcare variables influence the presence and severity of diabetes complications and their relationship with mortality. Our study utilizes anonymized administrative healthcare data on all diabetes patients of Hungary between 2010 and 2017. We construct settlement-year level and individual-year level panel datasets to analyse diabetes prevalence, incidence and complications, employing Poisson and logit models to explore associations between complications and the explanatory variables. The adapted Diabetes Complications Severity Index (aDCSI) is employed to quantitatively evaluate the severity of complications by aggregating individual complication scores from ICD-10 diagnosis codes. We find that diabetes prevalence and incidence are higher in settlements with above-median unemployment rates, where patients exhibit more severe complications, as shown by higher average aDCSI scores. Among socioeconomic factors, unemployment rate is particularly associated with increased aDCSI scores, while better healthcare access is associated with lower aDCSI scores in unadjusted but with higher scores in adjusted models. The presence and severity of complications, especially renal, cardiovascular and peripheral vascular ones, substantially increase 5-year inpatient mortality. Most of the mortality difference by settlement-level unemployment rate disappears when complications are accounted for. We conclude that socioeconomic inequalities, particularly higher unemployment rates, are strongly linked to diabetes complications and associated mortality risk. Addressing these disparities through improved healthcare accessibility and targeted public health strategies could play a crucial role in reducing the burden of diabetes-related complications and improving patient outcomes.